The purpose of this study is to measure the long-term adjustment of kidney transplant patients, both adult and children and to study the psychological reactions of living related kidney donors. An earlier study used quantitative measures and control groups to determine the quality of life, self-image, and rehabilitation of 156 adult transplant patients, and 52 transplanted children. Measures were obtained pre-transplant, a few weeks post-transplant and a year post-transplant in successful cases. At similar times, 112 related donors were measured. In addition, 205 families were followed intensively throughout the donor search. These studies indicated high levels of adjustment among, donors, and families; although certain more vulnerable sub-types were identified. It is unclear whether the high-level of adjustment for the majority is simply the short-term consequence of having successfully survived a major crisis or whether these favorable effects will persist. Currently these patients and donors are 5-7 years post-transplant and we propose to stuy their long-term reactions and rehabilitation. First of all, this study should help to evaluate the socio-psychological and ethical aspects of very expensive new technology. Are the patients experiencing a high enough quality of life to justify the cost? Many centers are reluctant to transplant children due to a presumed low level of rehabilitation. In fact, what is this long-term level of adjustment? Is the effect upon the related donors benign enough to recommend their continued use or does careful measurement of their reactions suggest ethical and psychological contra-indications to their use? What types of recipients and donors are particularly vulnerable and in need of extra support? Secondly, this study should contribute theoretical insights to the investigation of the long-term consequences of crisis for the self-image; the analysis of the impact of health status upon psychological adjustment; the study of family roles in illness and in help giving; the analysis of interpersonal altruism and gift-exchange; the exploration of the consequences of conflict and communication blockages for family cohesion over the long-run; and the identification of factors affecting the donor's responses to his own altruism and sacrifice.